A diagnosis of throat and mouth cancer will likely start with a visit to your primary care physician, who will obtain a thorough medical history and then perform a physical examination. This may also occur in the setting of a dental exam with your dentist. In addition, he or she will then utilize any of the following tools to arrive at a diagnosis:
An endoscopy is a procedure that involves passing a small camera down your mouth and into your throat to inspect the area for cancerous changes, masses, or infection. It requires sedation or anesthesia and will likely occur in a hospital or outpatient surgical setting. In the case of oral cancers, it allows excellent visualization of the mouth and throat.
A CT scan also uses x-rays to generate an image, but it has several advantages compared to the chest x-ray. It will show the precise location, shape, and size of masses. In order to obtain even sharper images, some patients are asked to drink or receive IV contrast. This contrast makes some tissues appear brighter, which makes the images and the structures more apparent and easier to discern. Allergies to contrast medium may cause hives, flushing, shortness of breath, and low blood pressure. If you have had a reaction to contrast before, you should inform your physician. In addition to masses (such as cancers), it can show enlarged lymph nodes, which may have cancer cells. Many patients will have CT scans of the chest, as well as the abdomen to look for cancer spread, which may involve the liver, adrenal glands, or other internal organs. The CT scan may also involve the brain to look for cancer metastasis. A CT scan may also be used to obtain biopsies of masses or cancers what lie deep within or nearby other vital structures, which is termed CT guided needle biopsy.
A magnetic resonance imaging (MRI) study also provides detailed soft tissue “pictures.” As opposed to CT scans, which utilizes x-rays, MRIs use magnetic radio waves to generate images. MRIs are particularly useful for imaging the brain and spinal cord. Gadolinium, a contrast, is often used to produce even better MRI images.
PET scans, also known as positron emission tomography, are especially useful to look for cancer spread. This study involves injecting a special radioactive sugar (flourodeoxyglucose, or FDP) into the vein. The amount of radioactivity is very low and will not cause you harm. After the injection, a special scanner will pick up areas in your body where the sugar has accumulated. As cancer cells are very active and require a great amount of energy (sugar), the FDP will concentrate in these areas. The PET scan does not produce extremely detailed images, but rather indicates spread of cancer throughout the body.
Bone scans can also be performed to detect spread of cancer to bones. During this procedure, a radioactive dye is injected in the vein, where is it transported to areas of bone with abundant activity, which may occur in cancerous and non-cancerous states.
A simple chest x-ray or radiograph will usually be performed, as it is convenient, cheap, and will reveal if the cancer has progressed to the lungs.
If a suspicious mass is identified via the aforementioned tests, a biopsy may need to be performed to ensure proper diagnosis. During a biopsy, a small amount of tissue is removed from the suspicious mass and then assessed under the microscope. A biopsy is commonly performed as a fine needle aspiration, or FNA, which utilizes CT imaging and a long, thin needle to pierce the skin and to obtain a small tissue sample of the mass. A pathologist will then study the biopsy to determine if the mass is benign or malignant and will then identify the exact type of malignancy.